Apparatus to indicate progressive exercise of injured sphincter muscles



May 16, 19% 25%,858

A. H. KEGEL APPARATUS TO INDICATE PROGRESSIVE EXERCISE 0F INJURED SPHINCTER MUSCLES Filed April 29, 1948 Patented May 16, 1950 APPARATUS TO INDICATE PROGRES- SIV E EXERCISE OF INJURED SPHINCTER MUSCLES Arnold H. Kegel, Los Angeles, Calif.

Application April 29, 1948, Serial No. 23,976

6 Claims.

This invention relates to a method of and apparatus for indicating or observing indirectly, progressive degrees of exercising injured sphincter muscles for the purpose of developing, reconstruction or regeneration of such muscles.

This application is directed to an improvement of the method and apparatus as set forth in my copending application filed January 13, 1947, Serial No. 721,822.

The principle upon which this invention is based is similar to that of my copending application in that muscles that are injured, torn, or which require development, are (or may be, be-

cause of their inherent characteristics, or their anatomical position, or their physiological function, or because of the injury or tearing thereof) difficult or impossible to observe or be cognizant of the fact of their function or loss of function.

Because of the inability of the individual to know of the functioning of such muscles, it is impossible for the individual to attain control of the muscles in a manner that will make it possible for the individual to redevelop or regenerate the muscles through use. This invention, therefore, is based upon the principle of providing a means of making it possible for the individual to become cognizant of, or know when their effort directed toward the use of such muscles is actually succeeding, and also making it possible at the same time for the individual to determine the fact of the utilization or activation of such muscles and the degree to which the individuals effort is succeeding.

As many of these muscles are injured to the point where they are practically useless, it becomes necessary to provide a means which is intensely sensitive to the slightest exertion of the muscles so that the individual may again attain the ability to exercise such muscles and then, by repeating the effort to exercise the muscles, attain full control thereof, and as the muscles are utilized to rebuild or regenerate the muscles through their use as determined by the means provided which makes the individual aware of the success of their efforts. The regeneration or reconstruction in the development of these muscles is to the greatest degree dependent upon the ability of the individual to use the muscles to exercise the same and through exercise and use to redevelop and reconstruct the same.

In accordance with my invention and method, it is possible for the individualto determine the fact of the slightest use or activation of the muscles by interposinga very sensitive medium between the muscles which is prestressed so that the slightest exertion against the prestressed membrane is recorded on a sensitive recording instrument visible to the individual enabling the individual to determine the fact that the muscles are being utilized and the degree of the success of their effort to exercise such muscles. v

In my copending application I have disclosed a method and apparatus of a character similar to that disclosed in this application with the exception that in that application I have shown a laterally expansible member which is inflated with air through a pressure bulb, making it possible for the degree of pressure within the inflated member to vary. From an operative and a psychological standpoint I have found this to be a detriment to the successful operation of my in vention and the use of the method thereof because the patient or patients utilizing such apparatus have a tendency to depend upon the operation of the inflating medium or bulb and when unable to immediately determine the success of their operation to utilize such muscles to vary the conditions of the operation of the apparatus through the medium providing for the inflation of the bulb and to thereby defeat their own purposes. In overcoming this diiiiculty, my present invention contemplates the use of a prestressed bulb operating under atmospheric pressure and independently of any inflating medium where the effort exerted against the bulb is opposed only by atmospheric pressure which is constant or substantially constant so that the results obtained are uniform and substantially without variation.

I have found that it is expecting too much to require an individual to determine the correct initial resistance by means of a compression bulb at the beginning of each exercise period. By establishing initial resistance at all times at atmospheric pressure and measuring the strength exerted against such minimum resistance has standardized the exercise and simplified the instructions.

It is therefore an object of my invention to provide a method and apparatus for use in making the individual aware of the functioning of the sphincter muscles not only as a matter of fact but as a matter of degree wherein there is provided a uniformly stressed bulb element adapted to be positioned within the muscles and which is connected with an indicating device so that the fact and degree of functioning of the muscles against such prestressed bulb element will be immediately discernible upon the indicating means to the individual.

A further object of my invention is to provide a method which will enable an individual to become aware of the slightest function of semivoluntary and involuntary muscles by providing a prestressed yieldable element against which such muscle is operating and which prestressed yieldable member is connected with a visual indicator enabling the individual to see .that the muscle .is' functioning and the degree .to which the muscle is functioning.

Another object of this invention is to provide an apparatus including a member insertable in a sphincter muscle and havingz=.a. prestressedi or yieldable tension diapln'agmelemenh extending over a core and against which prestressed yieldable diaphragm element the muscle-is exertedand to which yieldable element there is connected an indicating means enabling the individual-to see or know of the slightest exertion of such muscle indicating the fact of. such exertion or use and .the degree or strength of the muscle. being so "exerted.

1. Other objects and advantages of this invention j ity is believed will be" apparent from the followingdet'aileddescription *of a preferred embodiment thereofas illustrated in the accompanying .drawing.

.Infthe drawing: Figure 1 isa diagrammaticillustration of the apparatus embodying my invention.

figure 2 is a" fragmental sectional view of the insertable yieldable diaphragm element. and its supporting means.

Figure 3 is an end elevation taken substantially onthe line 3+3 of Figure 2.

; In the apparatus embodying my invention there is provided an insertable element I. which ,isadapted to be inserted in the sphincter muscle so that the muscle may be exerted thereagainst. The insertalole member. lincludesacore 2 hav- '.ing a, rounded head. 3 and being. providedat its .end opposite the head 3 with spaced flanges land Sbetween which the annulus 60f thebasefiange l positioned. The core 2 is provided with a longitudinally extending air passage 8 terminating in ;..a:.branch 9 in the core 2 and-within the flexible sdiaphraem l 6' which. slli Qunds: and covers the score. 2. The diaphragm .10. is formed ofa readily aaflexiblematerial such as rubber or. the like. in the a form. of.a'. tube .closedeat its..;end llrwhereijtis fixedover the head.3 .of the. .core 2 and :is;pro-

--vided. at its.opposite end with. a retainingflange or ring 12 which ispassed into. the annularspace provided betweeni-the flangesi 4. ..and i5. .and is clamped in-positin by means-of the annulus E-of the-base ring or flangef'l. f In 'this manner -the-diaphragml8 is slightlyepre tensioned or stretched over the core 80- as normally to main- -tain an air space l3- within its interior-and surrounding the coreZ. This-air--space is -maine tained atatmospheric-pressuredue to the ad-v mission of air through the air passages-8, 9'- and 16. At its rearwardmost'end the core 2 connected with a flexible'tube Mwhich extends to a hose [4 between its ends and provided a simple glass tube adapter l6 for connecting the free ends of the hose. Thus if at any time the pressure within the diaphragm I0 becomes depleted due to such a leak or other reason, it is a simple 10, By utilizing normal atmospheric pressure within "the diaphragm I0 I am assured of uniform conditionsrofloperation under all conditions, i. e., themuscularv effort which is exerted against the diaphragm neecF-only be sufficient to overcome 15 the slight. degree of tension of the rubber forming the diaphragm ID to be responded by a surge --ofpressure-irr.the air within the diaphragm l9 .and..to. indicate this pressure surge upon the pressure gauge I 5. Asthe pressure gauge is an 20..at. 0.$pheric pressure gauge, there is no pressure "diilierenceand conditions areuniform at all times. ",The' baseflange I is-sirnilar mall-respects toijth'at disclosed" in: my' copending application and provides a means which-is-substant-ially rigid ..in,providing a'stop for the insertion of the-diaphragm or. bulb element into the sphinctermuscle and at the same'time' provides a:means tor-holding the diaphragm in' position. during-=its ppera- ..,tion. ,A.slight compression of'the basefiange-l at.- its periphery, due to its-concave-formation will result. inJthe. pressure being 'exerted' -to-hold ,the'.diaphragm ,or'. bulb member-firmly in posi- .tion within,,the muscle.

.- As illustrated .this" baseilange" l is formed with ntheretaining .Jannulus 6 surrounding its .inner'. bore and. having radially extending reinforcingsl 1. spaced aroundthe bore in such man- ..nerQas .to. reinforcethesame and provide ;{the means which. causes' anj inward pressure to be exerted against the centralannulus 6 upon compressive effort beingexerted atthe periphery of the ,fiange to decrease. the. diameter of. .the base .flange inwardly. on its concave side.

.In theuse. of. the prestressed substantially atmospheriopres'surei diaphragm member 10' I have eliminated-danger. Of ba1l00ning the diaphragm -on compressionpp'to 1100mm. .Asthe diaphragm ..,is only subjectto atmospheric pressure, 'there' is no .liabilityof. ainbfeing containedwithin' the diaphragm at such .a pressure.asrmightresult'in ba11o0ni.ng.

In carrying out the method embodying myinvention the. :bulb or, diaphragm .member is" inserted inlthe. sphinctenmuscle to, the. point where i1 he. baseflan'ge l acts, asa stop. jlTheiiifal or pres- .sure, gauge .l5fis placed in position where'it may beg-observedrby. the, individual; 'L'The sphincter muscle is. contracted. againstthe diaphragmftl 0 andthe .fact of. such contraction of the muscle ,.is .immediatelynindicated ,by movement of the pointer [oil the. gauge 1| 5. ,Atjfirst, .infthe case of ,injuredmuscles. where. many jofthe muscle cells ..have' lost ,theirpower; to .contra'ct'and awareness of functionhas been 1ost','thedegree ofmovement pressure sensitive gauge I5- which is calibrated intbfihepointerwm be veryshght. 7A5 in thigmb 'such' a manner andis of such sensitivity as to record the slightest exertion'of-pressure against the diaphragm ID from *itsexterior-as might-be exerted thereagainst by the muscles under-con- 'sideration.

*In' order to simplify the apparatus and to'prevent .the interior ofthe diaphragm Ill frombeing exhausted of air as through a leak betweenthe connections of the tube or hose 14 with either'the provement of my invention the; pressure required to be overcome is onlythat of the degree often- "sion' placed in the diaphragm-lfl-which is-very slight,it' is possible'to record or observe thesli'ght- .est. degree of muscular exertion. With continued efiortrwhich-is'guided--by the oscillations ofthe pointer of the gauge 5;-contra'ction of the-muscle willbecome stronger and 'wilhbe made known to the individual by greateremovement :of the pressure gauge'15 or the core 2;I have-cut* the qs-pointer' of "the'gauge. -"ontinued= useof the muscles against the flexible diaphragm ID with continued improvement in the effort exerted as determined by the movement of the pointer of the gauge 15 is a direct measurement of the result of reinnervation and development, reconstruction or regeneration of the injured or atrophied muscle cells.

It will be observed that there can be no effort properly exerted unless there are means provided by which the individual making such exertion is cognizant of the effort and aware of the function thereof. Through the use of my method and apparatus it is possible for the individual to have an awareness of function and be cognizant of the slightest effort expended through the exercising of such sphincter muscles. It is also possible for the individual not only to become aware of the fact of the use of such semi-voluntary or involuntary muscles, but to know the degree of functioning of such muscles and thereby know of their use of such muscles and the fact that by such use they are reinnervating or reconstructing the atrophied muscle cells.

As set forth in my copending application, the use of the method and apparatus of my invention is carried out in conjunction with a graph or chart upon which the results of operation are recorded so that the individual is kept advised progressively of their effort and the results accomplished thereby.

As set forth in my said copending application, the method is utilized through the period of time sufflcient to enable the individual to become fully aware of and to obtain proper control of the muscles so that the use of such muscles is made known to the individual so that they can control such use and degree of muscular effort exerted. When the patient thus obtains control of the muscles and is enabled through being aware of their use to exert greater force against the diaphragm member 58, such use will start the reconstruction or rebuilding of the muscles. As the individual becomes better able to control the use of the muscles, a period will be found on repeated efiort where the muscles pass through a stage of development or strengthening as indicated by the degree of movement of the pointer or gauge [5 to a point of substantially constant reading upon the gauge which will persist for a period of time as the cells of the muscles are brought into play and into activity. As this period is passed through, the muscles will then start the process of reconstruction or reinnervation or building due to their continued use. The sphincter muscle has again been taught to exert pressure against a minimum of resistance, in other Words, has regained its normal function.

It will be apparent that my invention differs in principle from other means of exercising of such semi-voluntary or involuntary muscles in that it does not seek to exercise such muscles through outwardly-applied means, but is dependent upon making the individual aware of the fact of the functioning of such muscles to obtain the control thereof and to then enable the patient through continued use of the muscles and observing the degree of muscular force exerted thereby to rebuild or reconstruct the muscles through their actual use against resistance. While massage or electrical treatment or electrical stimulation of muscles may in many cases be helpful to stimulate blood circulation therein to thereby improve the nourishment to the muscles, there is no real comparison that can be made between massage or electrical stimulation and physiological efiort to reinnervate or reconstruct muscle tissue.

' Having fully described my invention, it is to be understood that I do not wish to be limited to the details herein set forth, but my invention is of the full scope of the appended claims.

I claim:

1. In a muscle exercising apparatus, the combination of a prestressed yieldable member adapted to be inserted in a sphincter muscle cavity and. having an atmospheric pressure air cavity therein, the yieldable member providing an atmospheric pressure diaphragm against which muscular con'tractive forces are exerted by the sphincter muscles, said yieldable member being connected with an indicating means operable in response to pressure exerted against the diaphragm for indicating and making the individual aware of the effort and degree of eifort extended to exercise the muscles against the said atmospheric pressure diaphragm.

2. An apparatus for the development and exercise of muscles in a cavity in the human body comprising a, rigid core member, a laterally compressible prestressed yieldable covering over the core member providing an atmospheric pressure diaphragm, said core member and said compressible member being adapted to be inserted into the muscular cavity, means connected with the diaphragm member and with an indicating means whereby pressure exerted against the diaphragm will be indicated upon the indicating means for indicating the results of efforts to contract the muscles of the muscular cavity.

3. In a muscle exercising apparatus, a laterally compressible prestressed yieldable covering forming a diaphragm, a core positioned within the diaphragm, means supported by the core for maintaining the covering stressed, and means providing a passage for the admission of air into the interior of the diaphragm as stressed over the core to maintain atmospheric pressure within the interior of the diaphragm, and means connecting the air passage with a pressure indicating means to indicate the fact of muscular contraction against the diaphragm.

4. An apparatus for the development and exercising of the muscles in a cavity in a human body consisting of a core member, a laterally compressible prestressed yieldable covering over the core member providing a diaphragm, means secured to the core providing a base flange providing means for maintaining the diaphragm stressed over the core, air duct means connecting the interior of the diaphragm with a pressure indicating means, the pressure indicating means providing a visual indicator so that muscular pressure exerted against the diaphragm will be visually indicated upon the pressure indicating means.

5. An apparatus for the development and exercising of the muscles in a cavity in a human body consisting of a core member, a prestressed yieldable covering over the core member providing a diaphragm, means secured to the core providing a base flange providing means for maintaining the diaphragm stressed over the core, air duct means connecting the interior of the diaphragm with a pressure indicating means, the pressure indicating means providing a visual indicator so that muscular pressure exerted against the diaphragm will be visually indicated upon the pressure indicating means, and means interposed in the conduit permitting opening of the 7 conduit :to theanormal .air pressure-:to-;maintain atmospheric pressure within the system.

6. In an zapparatus" for the'developmentvand exercise =:of :the sphincter muscles; an exercising element comprising a rigidcore having :aheadat one end, aupair of-lspaced flanges at its opposed end, a prestressed yieldable covering: over the core 2 providing .a A flexible diaphragm and being positionedzoverthe head of the core=andhaving its open endssecured in pressure-tight relation in the spaced flangesof the'core bya concave-convex: disc formed of relatively flexible material, which disc: has a thickened'center annular retainingringadapted to snugly 1% between the flanges of the core and embracing theend of the 'coreacovering-to. maintain the same in prestxessedcondition over the core means .for ad- 8 mitting airiunder atmospherio'pressuretowithin thencoveringzas prestressed 'over the core; and means-connecting :the --interior of the core 'with an; indicatingimeans to visually indicate thefact of: pressure: being; exerted by, such sphincter muscles against'saidhcovering diaphragm; .and said indicating means being operable to indicate the magnitude 0f the pressure so exerted;

ARNOLD H. KEGEL;

REFERENCES CITED The "following references are ofrecord in the fllof this-"patent? FOREIGN PATENTS Number" Country; Date 15,864-- Francenne July 24,-1912 

